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General NPI Number Information
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NPI Number | 1316913262
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Entity Type | Individual
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Provider Name | MICHAEL JOHN YANISH M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/28/2006
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Last Update Date | 02/16/2017
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Provider Practice Location Address
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Address Line | 5823 W EUGIE AVE STE A
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City | GLENDALE
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State | AZ
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Zip | 85304-1276
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Country | US
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Telephone | 602-843-1265
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Fax | 602-843-1297
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Provider Business Mailing Address
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Address Line | 3020 E CAMELBACK RD SUITE 300
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City | PHOENIX
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State | AZ
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Zip | 85016-5095
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Country | US
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Telephone | 602-264-9100
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Fax | 602-264-9101
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 17047
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License Number State | AZ
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